Rectus sheath hematoma in a single secondary care institution: a retrospective study.

PURPOSE: Rectus sheath hematoma (RSH) represents an unusual abdominal wall pathology, frequently confounded as acute abdomen, with high mortality rates reported especially among elderly patients. The purpose of this retrospective study was to delineate characteristics of the patients diagnosed with RSH at the First Surgery Department of the Saint George General Hospital of Chania, Greece over a 5-year period. METHODS: Seven patients with a median age of 62 years (range 51­85) were included in the study. Clinical features, demographics, management and outcome are summarized. RESULTS: The most common predisposing risk factor was anticoagulation. Acute onset abdominal pain and painful palpable abdominal mass, located more often on the right lower abdominal quadrant, were the most frequent initial symptoms. Management was mostly conservative [6 (85.7 %)] with disruption of anticoagulation, analgesia and bed rest. Blood transfusion was performed in hemodynamic compromised patients [2 (28.5 %)]. One patient was not appropriately diagnosed. On admission, the patient presented severe hemodynamic compromise and for this reason underwent emergency explorative laparotomy. The majority of the patients [6 (85.7 %)] experienced an uncomplicated clinical recovery and were discharged home after a mean hospital stay of 10 days (range 7­12). CONCLUSIONS: Surgeons as well as primary care physicians have to be aware of the clinical diagnostic tests and include the condition in the differential diagnosis of acute onset abdominal pain. Prompt recognition will prevent unnecessary surgical intervention and potential complications.

Primary omental torsion in a 9 year old girl: a case report.

Primary torsion of the omentus is an extremely unusual cause of acute abdomen in the pediatric population. This condition occurs from twist of the pedicle of the omental apron around its longer axis, leading to edema, ischaemia and necrosis. Here we present a rare case of a 9 year old girl referred by her general practitioner due to severe right lower quadrant abdominal pain with a presumed diagnosis of acute appendiceal inflammation. Surgical operation disclosed primary omental torsion. The infarcted segment was resected and the girl's clinical recovery was uneventful without any complication. The condition may mimic a variety of other causes of acute abdominal symptoms. In this case report, a presumed diagnosis of acute appendicitis urgently induced the decision of a surgical approach. Physicians involved in the acute pediatric care have to include this rare condition in the differential diagnosis of acute onset right-sided abdominal pain.

Rupture of a splenic artery aneurysm in a previously healthy 53-year-old male.

Splenic artery aneurysms are unusual clinical conditions that may be ruptured resulting into adverse health outcomes. Pregnancy, portal hypertension and atherosclerosis are conditions that predispose to the formation of splenic artery aneurysms. A rare case of a previously healthy man referred to our department by his general practitioner complaining of acute abdominal pain is presented. During the hospital stay, the patient presented hemodynamic instability. Abdominal computed tomography disclosed perihepatic and perisplenic fluid accumulation. A diagnosis of ruptured splenic artery aneurysm was performed and the patient was operated successfully with splenectomy and ligation of the splenic artery. Although the condition is rare, physicians have to be aware of the high mortality rates caused by a ruptured splenic artery aneurysm and include this in the differential diagnosis when they encounter patients with acute abdominal pain and hemodynamic instability.

Perforation of Meckel's diverticulum by a wood splinter in a 4-year-old child: a case report.

Perforation of Meckel's diverticulum by a foreign body represents an unusual and serious clinical occurrence. We present a case of a 4-year-old male who was admitted with symptoms of abdominal pain in the right iliac fossa, raising the suspicion of acute appendicitis. Exploratory laparotomy disclosed normal appendix and perforation of Meckel's diverticulum caused by a wood splinter. Meckel's diverticulectomy was performed and the child had an uneventful postoperative course. Preoperative diagnosis of perforated Meckel's diverticulum remains a challenging issue. Diagnosis should be considered in the presence of a right lower quadrant abdominal pain or a positive history of ingestion of a sharp foreign body.